FYI: You’re eager to buy your favorite candy bar. You go in the store. You pay the usual amount. But when you open the familiar wrapping you get a terrible surprise. It’s smaller, way smaller, than you expected.
Millions of Americans may have an experience like this in the future. Only it will be with something far more important. The shrunken candy bar will be their Social Security check. Benefits will be far smaller than expected if Social Security is “reformed.” The change would come through a bill submitted by Rep. Sam Johnson, R:Texas.
Regards,
Ted
https://assetbuilder.com/knowledge-center/articles/social-security-reform-if-youre-under-50-watch-out
Comments
In case it isn't obvious fixing s.s is a misery loves company strategy. (gradually raise the age, increase the % taking out of paychecks, increase the upper limit on whats the payroll tax is applied to. Exceptions on age can be made for jobs with a good deal of physical labor. For each of thjese changes make them as small as possible to get the job done. Basically rich ,poor ,middle class or suffer but not much
Raise the retirement age but only for income above the bend points. For example, set FRA at 67 (the current target) for the first $N, then 68 for payouts above the first bend point, and 69 for payouts above the second bend point. It's not perfect, but it does approximate keeping retirement age lower for more physical (typically lower paying) work.
It also means that no one is treated differently. Just like the graduated income tax, everyone is treated (taxed) the same on the first N dollars, then everyone is treated the same on the next M dollars, and so on.
This also makes the system a little fairer. Lower wage workers tend to have shorter lifetimes, and are thus deprived of their fair share of payouts (since everyone is assumed to have the same life expectancy). By giving the first N dollars of benefits at a lower age, those with lower incomes (and lower life expectancies) should come closer to getting on average their full benefits. Those with higher incomes (and longer life expectancies) will likewise come closer to getting on average their full benefits, and not more (due to greater longevity).
Levying payroll taxes on imports strikes me as simply levelling the playing field -- charging the same taxes as are currently levied on domestic production/workers.
Additionally, on Medicare, the program should have the ability to negotiate drug prices. Its scandalous that it doesn't:
http://healthaffairs.org/blog/2016/09/19/the-politics-of-medicare-and-drug-price-negotiation/
SS benefits will be taxed away for those who can support themselves without it as part of it is taxed away now.
Extending the age for eligibility does more harm (older workers try to hang on longer to their jobs - the young do not have jobs) and the fact is companies do not want older workers (higher pay/health costs then young) so they try to get rid of them.
Here's a pretty low-keyed discussion from the Council on Foreign Relations in 2012 titled: Healthcare Costs and U.S. Competitiveness
A few excerpts:
" At 12 percent, health care is the most expensive benefit paid by U.S. employers,"
"Some economists say these [high healthcare costs] ... can put [companies doing business in the US] at a substantial competitive disadvantage in the international marketplace. ... [O]ther experts debate the degree to which health care affects U.S. industries. 'Health benefits are largely substitutes for other forms of labor compensation...'"
"The 'Triple Tax' ... First, [businesses] pay for insurance programs through health benefits. Second [because Medicare/Medicaid don't pay full costs, everyone else covers providers' costs through higher insurance rates. Third, we all cover care for the uninsured] again through higher insurance premiums."
It goes on to discuss other problems with health coverage being provided through employers. That system is an historical fluke (companies offered "cheap", tax-exempt health insurance when they couldn't increase wages during WW2), not something inevitable or immutable.
http://www.npr.org/templates/story/story.php?storyId=114045132
But the bigger problem than health-insurance is healthcare COSTS (insurance is simply the intermediary). Obama consumed most (all?) of his political capital in getting the ACA enacted; too bad it did so little to address costs. And shame on both parties' refusal to directly tackle the healthcare costs in this country.
Blocked by the same people who complain about the cost of healthcare.
http://washingtonmonthly.com/2017/01/03/what-republicans-have-promised-on-health-care-reform/
Gosh, what promises.
1. Recent years' annual rates of increase are less than in earlier years, notably before ACA.
2. Recent years' annual rates of increase are not changing much; they are remaining flat at this relatively low rate of increase number (6.5%).
See picture below:
Having said that, the picture alone doesn't show what portion of the decline in annual cost increases is due to ACA and what portion is due to other factors.
The ACA does have some cost cutting measures, though nothing that strikes me as impressive. It requires insurers to spend at least 80-85% of premiums on actual care, not overhead. That primarily affects the price of insurance (you get a refund if less than 80% was spent on actual care). So it drives down insurance costs, but not health care costs.
It makes minor adjustments to Medicare payments, though as the CFR article I linked to notes, that could just shift the overall cost of care onto non-Medicare patients without reducing costs.
It encourages providers to form Accountable Care Organizations (ACOs) that focus on quality rather than quantity of care. These seem to be experimental, not something that has to date contained costs. Or as KFF puts it, "The Affordable Care Act (ACA) established several initiatives to identify and test new health care payment models that focus on [rising costs, quality of care, and inefficient spending]".
Accountable Care Organizations, Explained
https://www.whitehouse.gov/blog/2015/09/22/new-data-show-slow-health-care-cost-growth-continuing
https://morningconsult.com/wp-content/uploads/2016/12/12-22-16-The-ACA-Individual-Market-2016-Will-Be-Better-Than-2015-But-Achieving-Target-Profitability-Will-Take-Longer.pdf
http://www.cnbc.com/2016/12/21/record-number-of-obamacare-signups-on-healthcaregov-for-2017-health-insurance-coverage.html
http://www.taxpolicycenter.org/taxvox/repealing-affordable-care-act-would-cut-taxes-high-income-households-raise-taxes-many-others
(links, and others similarly pertinent, from
http://www.nytimes.com/2016/12/30/opinion/snatching-health-care-away-from-millions.html )
It says that it is "increasingly likely" that structural changes in the health care system are the leading causes of cost containment. It is correct in classifying government policy changes as structural changes. However, it gives no reason to believe that these government changes (and specifically the ACA), as opposed to other structural changes, were significant factors affecting costs.
No cause/effect theory, not even a description of the government policy changes. At best, a correlation between lots of things going on (including the ACA), and a decline in how fast costs are rising.
Second webpage: Talks strictly about insurer profitability, not cost containment. Says that their actuaries are getting better (that lack of experience was the reason for some ACA provisions that protected insurers until 2017). Says that the insurers are raising their premiums to reduce losses.
Third webpage: Lots of people signing up for 2017, despite double digit premium increases (see aforementioned phaseout of insurer protections).
Fourth webpage: Only talks about the taxes built into ACA, nothing about the impact of those taxes on the cost of providing health care. Ironically, it does mention one of the provisions of the ACA designed to slow the growth of costs. That's the Cadillac plan tax. It was designed to discourage insurance plans that make it easy to overuse resources and pay too much for them. But the page only mentions the tax impact, nothing about cost containment. Further, this tax doesn't kick in until 2018, so it couldn't be a factor in healthcare costs to date.
Fifth webpage: Krugman relies on your first page to say in effect: pay no attention to premium spikes because healthcare costs are not spiking. True, but it says nothing about why healthcare costs are not spiking.
I support the ACA because I think it is better than the only alternative on the table, viz. not having it. It makes health insurance available to many more people. And it helps to squeeze profits (notably by its 80-85% MLR requirement). But that's affecting prices, not costs.
I still see little in the ACA designed to contain health care costs. Here's a 2014 paper on what provisions are there. It's a heck of a lot more than most people think, but I'm still dubious about their efficacy.
http://www.chrt.org/publication/cost-containment-affordable-care-act-overview-policies-savings/
I am interested in the first sentence of your final para, as it is in contradiction to ACA claims made (perhaps wrongly). These pages actually may concur in your take, but flesh it out to some extent:
http://obamacarefacts.com/obamacare-control-costs/
Control provisions starts halfway down. I appreciate this little-known warning:
Remember anytime personal costs are curbed it is likely to raise healthcare spending, and new rules (even if they may curb costs in the long term) tend to increase costs in the short term (like dollar limits and minimum benefits).
This is the whole can, which you probably have read:
http://obamacarefacts.com/summary-of-provisions-patient-protection-and-affordable-care-act/
No I haven't read the full legislation. There's just so much nighttime reading one can take.
As a matter of fact, right now I'm trying to track down something I'm not sure is or isn't in the law - whether it allows you to be simultaneously covered by two exchange plans or two plans that are ACA qualified (one on, one off exchange). I thought I saw somewhere that this was not allowed, but don't see anything about it now.
I've found the ObamaCareFacts generally informative, though not necessarily precise. I was familiar with its page on cost controls. No time now to go through it again carefully. My impression was that some of it is solid, some is more wishful thinking/advocacy.
see if this is augmentative:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-charts-20170104-story.html
I thought you might enjoy this from the great Chait, esp the middle section about ACA genesis and process painstakingness:
http://nymag.com/daily/intelligencer/2017/01/every-gop-lie-about-passing-obamacare-is-true-about-repeal.html
That chart was part of a larger report that you can find here:
PWC, Medical Cost Trend: Behind the Numbers 2017
This report is oriented toward businesses - what to expect in terms of costs and how to adapt. The last section on this summary page is entitled "What this means for your business", and has bullet point suggestions for employers, for healthcare providers, for insurers, and for pharmaceutical companies.